Exams for thoracic outlet syndrome (alternative provocative test).

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Testing for thoracic outlet syndrome uses provocative maneuvers to reproduce symptoms by stressing the space where nerves and vessels pass through the outlet. Wright's test, known as the hyperabduction test, places the arm overhead in a high degree of abduction (often with the elbow flexed). This position narrows the costoclavicular space and the area under the pectoralis minor, increasing compression of the lower brachial plexus and/or subclavian vessels if there is outlet pathology. When such compression is present, the maneuver can reproduce symptoms and/or diminish the radial pulse, signaling a positive test. Allen's test checks hand perfusion rather than thoracic outlet compression, so it isn’t used to diagnose TOS. Adson's test targets scalene triangle compression, while Roos (Elevated Arm Stress) test is another provocative maneuver; Wright's test specifically stresses the pectoralis minor/costoclavicular region, making it a useful alternative in this context.